Nutritional status, weight evolution and eating behavior in university ...

Artículo Original

Nutr. clín. diet. hosp. 2014; 34(2):52-62 DOI: 10.12873/342cheli

Nutritional status, weight evolution and eating behavior in university students of health careers in Ribeirao Preto, Sao Paulo, Brazil Estado nutricional, evolução ponderal e comportamento alimentar em estudantes universitários de carreiras da área de saúde em Ribeirão Preto, São Paulo, Brasil Cheli Vettori, Josiane1; Covolo, Nayara2; Savegnago Mialich, Mirele3; Jordao Junior, Alceu Afonso4 1 2 3 4

Master’s Student, Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo. Ribeirao Preto, SP, Brazil. Nutritionist, Sao Jose do Rio Preto, SP, Brazil. Postdoctoral Student, Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo. Ribeirao Preto, SP, Brazil. Professor, Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo. Ribeirao Preto, SP, Brazil.

Remitido: 5/septiembre/2013. Aceptado: 4/septiembre/2014.

RESUMO Introdução: O estado nutricional e o comportamento alimentar dos universitários estão relacionados com fatores sócio-econômicos, culturais e ambientais, revelando efeitos diferentes no atendimento às necessidades nutricionais desses indivíduos. Objetivos: Analisar hábitos alimentares, evolução ponderal e imagem corporal de universitários da área da saúde do Campus de Ribeirão Preto da Universidade de São Paulo (USP). Métodos: Estudo transversal com 501 estudantes matriculados em cursos da área da saúde da USP do Campus de Ribeirão Preto. Houve aplicação de questionário envolvendo informações sócio-demográficas, do número de refeições, evolução ponderal após ingresso na universidade, além de informações sobre as percepções de imagem corporal dos universitários e de seus pais. Aferiu-se estatura e peso, composição cor-

Correspondence: Mirele Savegnago Mialich [email protected]

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poral (massa gorda, massa livre de gordura e água corporal) foi determinada através da bioimpedância e calculou-se o Índice de Massa Corporal (IMC). Resultados: Os 501 universitários estavam distribuídos nos cursos de Medicina (12,4%), Enfermagem (18,5%), Nutrição e Metabolismo (19,5%), Fisioterapia (15%), Educação Física (11,8%), Fonoaudiologia (8,8%), Informática Biomédica (8,6%) e Terapia Ocupacional (5,4%). Os estudantes possuíam uma média de idade de 20,4±2,8 anos e de IMC de 22,4±3,4 Kg/m2, sendo a maioria solteiros (98,80%), sexo feminino (73,05%), não tabagistas (96,2%) porém com presença da ingestão de bebida alcoólica (66,0%). Com relação aos comportamentos alimentares foram encontradas as médias de refeições realizadas pelos universitários diariamente e, destas, as realizadas dentro das dependências do Campus universitário, sendo respectivamente: café da manhã (83,8% e 3,99%), lanche da manhã (34,1% e 23,7%), almoço (99,6% e 82,8%), lanche da tarde (69,6% e 41,7%), jantar (93,4% e 29,5%) e ceia (30,1% e 0,19%), totalizando uma média de 4,12 ± 1,08 refeições diárias e de 1,81 ± 0,92 refeições realizadas no Campus. Quanto à evolução ponderal,

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avaliou-se se houve ganho, perda ou manutenção de peso após o ingresso na Universidade, sendo encontrado valores semelhantes entre os gêneros, sendo para homens (44,4%, 15,5% e 40% e 49,7%) e mulheres (49,7%; 23,4% e 26,7%), respectivamente. Referente à auto-imagem 61,47% dos universitários classificaram-se como normal e atribuíram a mesma classificação da percepção corporal de seu pai (42,31%) e mãe (54,09%). Conclusões: Considerando este estudo, foi detectado que a maioria dos estudantes está na faixa de eutrofia, de acordo com o IMC, além da presença de estudantes que progrediram para o ganho de peso após o ingresso na universidade. Mudanças no comportamento alimentar e etilismo também foram encontrados nesta fase da vida. Finalmente, a universidade tem o papel de introduzir programas que auxiliem os estudantes nas suas escolhas alimentares e de estilo de vida, a fim de promover e preservar a saúde. PALAVRAS-CHAVE Comportamento alimentar, evolução ponderal, percepção corporal, autoimagem corporal, universidade. ABSTRACT Introduction: The nutritional status and eating behavior of university students are related to socioeconomic, cultural and environmental factors, with different effects in terms of meeting the nutritional needs of these individuals. Objectives: To analyze the eating habits, weight evolution and body image of university students in the heath area of the Ribeirao Preto Campus, University of Sao Paulo (USP). Methods: A cross-sectional study was conducted on 501 students enrolled in health area courses of USP, Ribeirao Preto Campus. A questionnaire was applied in order to obtain sociodemographic data, number of meals and weight gain after entering the university, as well as information about the students’ perception of their own body image and of the body image of their parents. Height and weight were measured, body composition (fat mass, fat free mass and body water) was determined by bioimpedance and the body mass index (BMI) was calculated. Results: The 501 university students were enrolled in the courses of Medicine (12.4%), Nursing (18.5%),


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Nutrition and Metabolism (19.5%), Physiotherapy (15%), Physical Education (11.8%), Speech Therapy (8.8%), Biomedical Informatics (8.6%), and Occupational Therapy (5.4%). Mean student age was 20.4±2.8 and mean BMI was 22.4±3.4 kg/m2, the majority of students were single (98.80%), females (73.05%), not smoking (96.2%) but with consumption of alcoholic beverages (66.0%). Regarding eating behavior, the mean percentages of daily meals taken by the students and of those taken on the premises of the university Campus were, respectively: breakfast (83.8% and 3.99%), morning snack (34.1% and 23.7%), lunch (99.6% and 82.8%), afternoon snack (69.6% and 41.7%), dinner (93.4% and 29.5%), and supper (30.1% and 0.19%). Regarding weight evolution was evaluated whether there was a gain, loss or weight maintenance after entering at the University, and it was found similar values between genders, with men (44.4%, 15.5% and 40% and 49.7%) and women (49.7%, 23.4% and 26.7%) respectively. Regarding self-image, 61.47% of the students classified themselves as normal and reported the same classification of body perception of their father (42.31%) and mother (54.09%). Conclusions: regarding this study it was detected the majority of students in the eutrophic range, according to BMI, and the presence of students who progressed to weight gain after university entrance. Changes in eating behavior and drinking habit were also found in this stage of life. Finally, the university should introduce programs to help the students in food a life style choices in order to promote and preserve their health. KEY WORDS Eating behavior, weight evolution, body perception, body self-image, university. INTRODUCTION The human choice of foods is described as a complex process involving a multiplicity of influencing aspects such as the socioeconomic and cultural context, the access to and availability of food, as well as the educational level and age range of a person1,2. Thus, the global context surrounding an individual has an impact on life style factors such as food choices, the nutritional value of the diet, alcohol consumption and smoking, a reality also present among university students3,4.

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STATUS, WEIGHT EVOLUTION AND EATING BEHAVIOR IN UNIVERSITY STUDENTS OF HEALTH CAREERS IN

According to this general view, studies have revealed that entering the university can be seen as a period of greater vulnerability regarding the beginning and the maintenance of habits such as the use of alcohol and of other drugs5,6. Several authors have also pointed out that the eating habits of these individuals, as well as tobacco use and alcohol intake may be influenced by the new social context experienced, characterized by new social relationships, behaviors and situations, and physical and mental stress, also possibly leading to eating disorders during the undergraduate period7,8. Mattos and Martins9 have pointed out that the life style and eating habits of university students are strongly influenced by factors arising in parallel to entering the university, such as leaving family life and starting to have experiences with other, previously unknown, students in student housing, and beginning new social relationships and discoveries. Add to this the increased academic responsibilities and the consequent lack of time to eat meals in an appropriate manner, which lead to the consumption of practical and fast high-calorie snacks of low nutritive value, known as “fast food”. According to this scenario, university students may be in a vulnerable condition and may be classified as being in a situation of nutritional risk, since this period may favor undesired weight gain possibly accompanied by the onset of chronic diseases and changes in body perception10. In this respect, Dinger & Waigandt stated that, in the age range of 18 to 24 years of many university students, the establishment of healthy life behaviors, including eating behavior, may have a lasting impact on the health of these individuals and consequently on the health of their future families11. This becomes even more relevant regarding university students in the health area, who will perpetuate their acquired habits not only for themselves and their relatives, but also for the future community of patients covered by their professional activity. On the basis of these premises, it is necessary to observe the impact of the university context on the eating behavior of the students in order to identify factors that influence their nutritional status and quality of life. Thus, the objective of the present study was to evaluate factors that influence the nutritional status of students of the University of Sao Paulo (USP) and their relation to the eating behavior, weight evolution and body perception of these individuals.

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RIBEIRAO PRETO, SAO PAULO, BRAZIL

SUBJECTS AND METHODS

Subjects A cross-sectional study was conducted on a sample of 501 healthy university students of both genders, consisting of 197 adolescents aged 17-19 years and 304 adults with 20 years or more, who were duly enrolled in the following undergraduate courses in the health area of USP on the Ribeirao Preto Campus, SP: Medicine, Nutrition, Speech Therapy, Physiotherapy, Occupational Therapy, Biomedical Informatics, Physical Education, and Nursing. The study was approved by the Research Ethics Committee of the University Hospital, Faculty of Medicine of Ribeirao Preto, USP (Protocol HCRP no 1955/2010). The courses were selected at random and by convenience and all students of a class were invited to participate. They were informed about the objectives and methodology of the study and then scheduled for data collection. On the scheduled date, each subject gave written informed consent to participate in the study and was then submitted to measurement of weight and height and to the application of a questionnaire specifically elaborated by the authors for the present study. Exclusion criteria were: inability to walk, amputation, and having no tie to the Campus as an undergraduate student. All students participated voluntarily and were evaluated only once during the study by a group of trained examiners.

Anthropometric evaluation Weight (kg) was measured with an electronic scale, BC-558 Ironman Segmental Body Composition Monitor (Tanita Corp., Tokyo, Japan), with a maximum capacity of 150 kg and precision of 0.01 kg. This measurement was made after a fast of at least 5 hours, followed by emptying of the bladder, with the subject barefoot and wearing light clothing. Height was measured with a plastic tape attached to a wall with no baseboard and with the aid of a wood rod, with the students standing up straight with head and neck aligned, and barefoot. Height (m) was measured in duplicate, with a maximum variation of 0.5 cm between measurements, with the mean value was calculated12. The body mass index (BMI) was calculated according to the equation BMI = weight (kg)/height (m)2 and classified according to the criteria proposed by the WHO (1995) indicating malnutrition (BMI < 18.5), normal weight (BMI from 18.5 to 24.9), overweight (BMI from 25 to 29.9) or obesity (BMI ≥ 30)13.


NUTRICIÓN CLÍNICA

Demographic and dietary pattern questionnaire

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the sample as a whole, 20.8 ± 3.2 years for men, and 20.3 ± 2.7 for women, with no significant difference between groups. Mean BMI was 22.4±3.4 kg/m2, mean fat-free mass was 45.3±10.3 kg and mean fat mass was 24.0±7.5%, with all of these variables showing significant differences between genders. The anthropometric and body composition characteristics of the university students are presented in Table 1.

We used a questionnaire specifically elaborated for the present study by a team of trained investigators based on the existing literature, containing objective questions and closed response options, for the collection of relevant information regarding the objectives of the study. The questions concerned demographic data (gender, age, place of birth, marital status, ethnicity), alcohol drinking and smoking, the course in which the student was enrolled, the semester and year of the course, employment contract, housing situation in Ribeirao Preto, SP, daily meals taken, type of predominant diet while staying on the USP campus, as well as information about the history of weight evolution since the student entered the university.

Most students (98.8%) were single and most resided with their families (55.68%) or alone (30.16%). A small percentage of students had an employment contract (6.18%) and many students had recently entered the university, being enrolled in the 1st year of the course (42.71%). In addition, most of these future professionals in the health area reported that they ingested some type of alcoholic beverage (66.06%), whereas few reported that they were smokers (3.8%).

The same questionnaire also contained questions about self-perception of one’s own body image and the body image of one’s parents, with the students being invited to classify their perceptions within five categories: very thin, thin, normal, fat, and very fat.

The information obtained revealed that the main daily meals taken by the students were breakfast (83.83%), lunch (99.6%) and dinner (93.41%), with lunch, afternoon snack and dinner being usually taken more within the physical premises of the campus (82.83%, 41.71% and 29.54%, respectively).

Statistical analysis

RESULTS

The data regarding weight evolution revealed that many students (48.3%) gained weight (mean gain of 4.36 ± 2.94 kg), whereas 21.35% reported a weight loss (mean of 3.54 ± 3.41 kg) or weight maintenance (30.33%) after entering the university. The sociodemographic characteristics and dietary patterns obtained with the above questionnaire are listed in Table 2.

The study was conducted on 501 university student in the health area. Mean age was 20.4 ± 2.8 years for

Also according to Table 2, and considering the genders differences, it is possible to notice that drinking

Descriptive analysis was performed, the Student t-test was used to compare means, with the level of significance set at p < 0.05 in all analyses. The Statistical Package for the Social Sciences 15.0 (SPSS) was used for statistical analysis.

Table 1: Anthropometric and body composition characteristics of university students in the health area of USP-RP. All (501)

Males (135)

Females (366)

P value

Weight (kg)

63.0±13.5

76.9±13.6

57.8±9.2

< 0.001*

Height (m)

166.9±9.0

177.3±6.7

163.1±6.3

< 0.001*

BMI (kg/m2)

22.4±3.4

24.4±3.8

21.7±3.0

< 0.001*

Fat-free mass (kg)

45.3±10.3

60.0±7.7

39.8±3.8

< 0.001*

Fat mass (%)

24.0±7.5

17.0±6.2

26.6±6.2

< 0.001*

Total body water (%)

55.8±5.2

59.9±5.3

54.3±4.4

< 0.001*

N

Data are reported as mean ± SD. *Significant difference of t-test (p< 0.05) between males and females.


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Table 2: Replies of the participants to a questionnaire containing demographic and eating pattern questions. Questions

Q1. Which undergraduate course are you enrolled in?

Replies

Total (%)

A. Medicine

N= 62(12.4%)

B. Nutrition

N= 98(19.6%)

C. Speech therapy

N= 44(8.8%)

D. Physiotherapy

N= 75(15.0%)

E. Occupational therapy

N= 27(5.4%)

F. Biomedical informatics

N= 43(8.6%)

G. Physical education

N= 59(11.8%)

H. Nursing

N= 93(18.6%)

A. First

N= 214(42.71%)

B. Second

N=130(25.94%)

C. Third

N= 99(19.76%)

D. Fourth

N= 57(11.37%)

Q2. Which year are you attending? E. Fifth

N= 1(0.19%)

F. Sixth

N= 0 (0.0%)

A. Male

N=366(73.05%)

B. Female

N= 135(26.95%)

A. White

N= 424 (84.6%)

Q3. What is your gender?

B. Mulatto

N= 51(10.1%)

C. Yellow

N= 19(3.8%)

D. Black

N= 7(1.4%)

A. Married

N= 6(1.2%)

Q4. What is your color?

B. Single

N=495(98.8%)

Q5. What is your current marital status? C. Divorced/separated

N= 0 (0.0%)

D. Widowed

N= 0 (0.0%)

A. Yes

N= 331(66.06%)

B. No

N= 170(33.93%)

A. Yes

N=19 (3.8%)

B. No

N= 482(96.2%)

A. Yes

N= 31(6.18%)

B. No

N= 346(69.06%)

C. Others

N= 124(24.75%)

A. Family home

N= 279(55.68%)

B. Alone

N= 151(30.16%)

Q6. Do you consume alcoholic drinks?

Q7. Do you smoke?

Q8. Do you have a job contract?

Q9. What is your housing situation in Ribeirão Preto?

56

C. With other students

N= 43(8.58%)

D. With a spouse

N= 19(3.79%)

E. With a boy/girl friend

N= 9(1.79%)


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Table 2 continuación: Replies of the participants to a questionnaire containing demographic and eating pattern questions. Questions

Q10. Where do you predominantly take your meals while you are on Campus?

Replies

Total (%)

A. Central restaurant

N= 397(79.24%)

B. Lancheonette

N= 163(32.53%)

C. Self-service restaurant

N= 113(22.55%)

D. Brought from home

N= 102(20.35%)

A. Breakfast

N= 420(83.83%)

B. Morning snack

N= 171(34.13%)

C. Lunch

N= 499(99.6%)

D. Afternoon snack

N= 349(69.66%)

E. Dinner

N= 468(93.41%)

F. Supper

N= 151(30.13%)

Q11. What meals do you take during the day?

A. Breakfast

N= 20(3.99%)

B. Morning snack

N= 119(23.75%)

C. Lunch

N= 415(82.83%)

D. Afternoon snack

N=209(41.71%)

E. Dinner

N= 148(29.54%)

F. Supper

N=1 (0.19%)

Q12. Which of these meals you take on Campus?

Q13. How did your weight evolve since the beginning of your undergraduate course?

Q14. How do you classify yourself?

Q15. How do you classify your father?

Q16. How do you classify your mother?

A. Maintenance

N= 152 (30.4%)

B. Gain

N= 242(48.3%)

C. Loss

N= 107(21.3%)

A. Very thin

N= 16(3.1%)

B. Thin

N= 90(18.0%)

C. Normal

N= 308(61.5%)

D. Fat

N=84 (16.8%)

E. Very fat

N= 3(0.6%)

A. Very thin

N= 7(1.5%)

B. Thin

N= 73(15.0%)

C. Normal

N= 212(43.8%)

D. Fat

N= 181(37.4%)

E. Very fat

N= 11(2.3%)

A. Very thin

N= 7(1.4%)

B. Thin

N= 63(12.7%)

C. Normal

N= 271(54.4%)

D. Fat

N= 147(29.5%)

E. Very fat


N= 10(2.0%)

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alcoholics is a present habit at this life stage, being reported by 74.0% of men and 63.3% of women, while the opposite happened with smoking, because only 9.6% of men and 1.9% of women reported smoking habit. Both genders make your meals, especially in the central restaurant while studying at university, being 89.6% and 75.4%, for men and women, respectively. And the average number of daily meals consumed on campus was around 1.8 meals / day for both sexes. As to the weight gain, the data for gain, loss or weight maintenance were distributed, respectively, as follows between genders: 44.4%, 15.5% and 40% among men and 49.7%, 23.4% and 26.7% for women, and for both predominated weight gain after entering university.


(Table 3), a classification they also attributed to the body image of their parents (Table 4). The criteria adopted for the classification of image self-perception were too fat, fat, normal, thin and very thin and both genders presented similar distributions, respectively, for this classification ranges, as being for men (0, 18.5%; 57.0%, 20.7%, 3.7%) and women (0.8%, 16.1%, 63.1%, 16.9%, 3.0%). However, curiously, even though most of the students considered themselves normal, some malnourished individuals according to BMI classified themselves as normal (1.99%); normal individuals classified themselves as very thin (1.97%) or very fat (0.19%); overweight individuals classified themselves as normal (8.58%), obese students classified themselves as normal (0.19%) and, interestingly, none of the obese individuals classified themselves as very fat.

The great majority of the students considered themselves normal in terms of body image self-perception

Table 3: Relationship between reported body image self-perception and nutritional status according to the BMI of university students on the Ribeirao Preto Campus of USP. Reported body image self-perception Nutritional status (BMI)

Very thin (N/%)

Thin (N/%)

Normal (N/%)

Fat (N/%)

Very fat (N/%)

Total (N/100%)

Male

3 (2.2)

2 (1.5)

1 (0.7)

-

-

6 (4.4)

Female

7 (1.9)

28 (7.6)

9 (2.5)

-

-

44 (12.0

Male

2 (1.4)

26 (19.2)

47 (20.0)

3 (2.2)

-

78 (57.8)

Female

4 (1.0)

34 (9.2)

207 (56.5)

25 (6.8)

1 (0.2)

271 (74.0)

Male

-

-

28 (20.7)

12 (8.9)

-

40 (29.6)

Female

-

-

15 (4.0)

28 (7.6)

2 (0.5)

45 (12.3)

Male

-

-

1 (0.7)

10 (7.4)

-

11 (8.2)

Female

-

-

-

6 (1.6)

-

6 (1.64)

Male

5 (3.7)

28 (20.8)

77 (57.0)

25 (18.5)

-

135 (100)

Female

11 (3.0)

62 (17.0)

231 (63.1)

59 (16.1)

3 (0.8)

366 (100)

Malnutrition

Normal weight

Overweight

Obesity

Total

58


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Table 4: Relationship between reported body image self-perception and body image perception that the students have of their parents. Perception of body image of the parents

Body image self-perception Very thin (N/%)

Thin (N/%)

Normal (N/%)

Fat (N/%)

Very fat (N/%)

Total (N/100%)

F

-

3 (0.6)

2 (0.4)

2 (0.4)

-

7 (1.4)

M

-

-

6 (1.2)

1 (0.2)

-

7 (1.4)

F

4 (0.8)

17 (3.5)

37 (7.6)

15 (3.0)

-

73 (15.0)

M

4 (0.8)

20 (4.0)

23 (4.6)

14 (2.8)

2 (0.4)

63 (12.6)

F

8 (1.6)

37 (7.7)

137 (28.3)

29 (6.0)

1 (0.2)

212 (43.9)

M

9 (1.8)

48 (9.6)

182 (36.6)

31 (6.2)

1 (0.2)

271 (54.4)

F

3 (0.6)

30 (6.2)

118 (24.4)

29 (6.0)

1 (0.2)

181 (37.4)

M

2 (0.4)

18 (3.6)

93 (18.7)

34 (6.8)

-

147 (29.5)

F

-

1 (0.2)

3 (0.6)

7 (1.5)

-

11 (2.3)

M

1 (0.2)

1 (0.2)

4 (0.8)

4 (0.8)

-

10 (2.0)

F

15 (3.0)

88 (18.2)

297 (61.4)

82 (17.0)

2 (0.4)

484 (100)

M

16 (3.2)

87 (17.5)

308 (61.8)

84 (16.9)

3 (0.6)

498 (100)

Very thin

Thin

Normal

Fat

Very fat

Total

F: father and M: mother.

DISCUSSION The present study revealed that university students were in the normal weight range according to BMI (22.4 ± 3kg /m2), presenting average levels of fat mass compatible with cutoffs recommended for adults by the WHO14, and for men found 17.0 ± 6.2% (fat mass cutoff